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NPI Code Detail

MEDICARE: JACK MULVIHILL

MEDICARE: JACK MULVIHILL
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1363AM0700XMedical Physician AssistantNY

General Provider Information

NPI Number : 1093414526
Entity Type Code : Individual
Provider Name (Legal Business Name) : JACK MULVIHILL
Provider Business Mailing Address
First Line : 174 CANTERBURY RD
Second Line :
City : SYRACUSE
State : NY
Zip : 13214-2243
Country : US
Telephone Number : 315-956-3215
Fax Number :
Provider Business Practice Location Address
First Line : 174 CANTERBURY RD
Second Line :
City : SYRACUSE
State : NY
Zip : 13214-2243
Country : US
Telephone Number : 315-956-3215
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 02/23/2023
Last Update Date : 05/08/2025

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